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Burying Freud

[ Burying Freud Homepage | Freud's Seduction Theory Homepage ]

EDITORIAL REVIEW

THE ASSAULT ON FREUD

Jeremy Holmes
Department of Psychiatry, North Devon District Hospital, Barnstaple,
Devon, UK, EX 31 4 JB.

Throughout its hundred-year history psychoanalysis has aroused violent passions. Calls to 'bury Freud' [1] continue unabated. The lines of these attacks have changed little since Eysenck`s ill-tempered bromide, now itself shown to be thoroughly flawed as a study [2]. Psychoanalysis is claimed to be unscientific -- either in a Popperian sense irrefutable [3], ineffective, or beneficial only via its placebo quality [4]. The psychoanalytic movement is likened to a cult, with its dogmata and high priests [5]. Freud himself is debunked, and claimed to be a cheat, a liar, an adulterer and an irascible paranoid sexist [6]. He is, in the 'seduction hypothesis', held responsible both for the misery of thousands of wrongly accused parents via the False Memory Syndrome [1], and, by his subsequent renunciation of the hypothesis, for the traumata of even greater numbers of children who actually were abused [7]. 

If this were merely an academic debate, Freud-bating might be seen as no more than a literary pastime, fostered by the publishing industry and academe, but of little practical significance in the world of psychotherapy. But as the market encroaches more and more on health-care such virulent attacks begin to take on a more definite and sinister shape. Health planners are in search of quick fixes -- briefer and cheaper alternatives to the costly treatments of the past. The psychotherapeutic equivalent of keyhole surgery is Cognitive Behaviour Therapy (CBT) which is set fair to become the dominant paradigm, at least within public-sector psychotherapy. In an age of pluralism, psychoanalysis is seen as merely one of 'the psychotherapies', and, according to some [8], an inessential one at that. Within the National Health Service, CBT is probably the most widely practiced variety of formal psychotherapy, especially among psychologists.

Should we welcome these developments., or will psychoanalysis, like hysteria, 'outlive its obituarists'? Mark Twain-like, are reports of its demise greatly exaggerated? It must first be acknowledged that the critique of psychoanalysis is not without foundation. Although there is fairly convincing evidence that psychoanalytic psychotherapy can be effective (see Barber & Ellman below), much work remains to be done, both at the level of outcome research and in probing the mode of action of psychoanalysis [9]. Psychoanalysis has been at times sequestered from the mainstream of academic debate, and has failed to take account of the findings of cognitive science, child development and even brain biochemistry in its world-view. As a movement it has been hierarchical, undemocratic and intolerant of dissent. No doubt Freud, and the other analytic pioneers were fraily human, not immaculate Gods.

But behind the attack on psychoanalysis lie a number of uncomfortable questions about the newer therapies, and a rediscovery of psychoanalytic concepts in a new guise. Long-term follow-up studies suggest that the initial enthusiasm for brief therapies such as CBT needs to be tempered. There is evidence that the relapse rate following brief therapy is disturbingly high -- five years post-treatment, as few as 20% of depressed patients remain relapse-free [10]. Co-morbid personality disorders dramatically worsens the prognosis of Axis 1 disorders. Some theoreticians such as Teesdale [11] have begun to question whether the supposed 'active principle' of CBT (questioning negative assumptions, finding alternatives to dichotomous thinking, challenging rules etc) is really what leads to change. Teesdale argues that the key ingredient is CBT`s capacity to help the patient to find new meanings and contexts for problematic feelings, and thus 'disidentify' himself from his symptoms -- which seems to bring us back to the psychoanalytic notion of insight. CBT practitioners [12] addressing the problems of personality disorder advocate much longer treatments than is traditional, and emphasise the importance of the therapist-patient relationship, including an understanding of transference and countertransference, as a determinant of outcome. 

Meanwhile contemporary psychoanalysis has moved a long way from classical metapsychology [9]. The unconscious is no longer seen primarily as a repository of infantile sexuality locked away by repression, only to be lifted by the arcane rituals of dream-interpretation. The Sandler`s [13] notion of the 'present unconscious' suggests that the main focus of psychoanalytic psychotherapy is on the thoughts, phantasies, and actions evoked in the patient by the therapeutic situation itself, and only secondarily on possible connections between these and the 'past unconscious'. This 'present unconscious' is clearly akin to CBT`s notion of 'automatic thoughts'. Unconsciousness is no longer seen as all-or-none, but as a gradation from vague awareness to full affective mastery (see Shapiro`s article below), and as a phenomenon is scientifically justified by the notion of unconscious perception [14]. Splitting and projection have taken over from repression as central mechanisms of defense: the aims of therapy are to reduce splitting and to lead to a more coherent and integrated sense of self -- highly relevant to the patients with borderline personality disorder who prove to be so problematic within psychiatric settings. Infantile sexuality is recast in terms of attachment theory in which adult personality is shaped by early attachment experience based around parental attunement, intrusiveness or neglect [15]. The oedipal situation, Freud's 'kernel of the neuroses', is today seen more as a metaphor than a description of real childhood events. The capacity to tolerate difference and separation, to use words and to reflect on oneself, all components of psychological health and thus aims for psychoanalytic psychotherapy, are seen in terms of the pain and gain of the 'depressive position' in which parental intercourse and ambivalence are accepted.

 The assault on Freud should not blind us to the immense contribution, both theoretical and practical, that psychoanalysis can make to psychotherapy. Psychotherapy needs psychoanalysis for three main reasons. First because psychoanalysis is in essence a science of relationships, and understanding relationships is close to the heart of psychotherapy, especially the balance between intimacy and boundaries that the psychoanalytic model has studied so intensively. Second, because psychoanalysis has emphasised so strongly the importance of early childhood temperament and handling as determinants of adult personality, a perspective that finally is beginning to be accepted in the wider world of psychiatry. Third, because psychoanalysis provides a guide to the inner world, offering a language for feelings that enables dumb suffering to be spoken, mental pain to be expressed.  

According to Whitehead a science which fails to forget its founders is doomed. Although psychoanalysis continues to pay due respect to its founder, Freud's presence often appears to loom larger in the eyes of its critics than its adherents. As psychoanalysis looks to the future, fruitful avenues of cross-fertilisation are opening up, among others with CBT and attachment-based therapies such as Interpersonal Therapy. If therapists can grasp these opportunities, and not be deflected by transient fashion or economic imperative, hybrid vigour will set psychotherapy in good shape for the 21st Century.

Jeremy Holmes

References

1. Tallis R: Burying Freud Lancet 1996, 347: 669-671.

2. McNeilly C, & Howard K: The effects of psychotherapy; a reevaluation based on dosage Psychotherapy Research 1991,1: 74-78.

3. Medawar P: Victims of psychiatry New York Review of Books 1975, Jan 23: 17-25.

4. Grunbaum, A: The Foundations of Psychoanalysis: A Philosophical Critique. Berkely: University of California Press; 1984.

5. Gellner E: The Psychoanalytic Movement. London: Paladin; 1985.

6. Webster R: Why Freud Was Wrong: Sin Science and Psychoanalysis. London: Harper Collins; 1995.

7. Masson J: The Assault on Truth: Freud`s Suppression of the Seduction Theory. London: Penguin; 1985.

8. Andrews G: The essential psychotherapies British Journal of Psychiatry 1993, 162: 447-451.

9. Bateman A, Holmes J: Introduction to Psychoanalysis: Contemporary Theory and Practice. London: Routledge; 1995.

10. Roth A, Fonagy P: Research on the Efficacy and Effectiveness of the Psychotherapies. London: Department of Health; 1996.

11. Teesdale J: The relationship between cognition and emotion: the mind-in-place in mood disorders. In D Clark & C. Fairburn (eds) Cognitive Behaviour Therapy: Science and Practice. Oxford; OUP; 1996.

12. Linehan M: Cognitive behaviour Therapy of Borderline Personality Disorder. New York: Guilford; 1993.

13. Sandler J, Sandler A-M: The past unconscious, the present unconscious and the interpretation of the transference Psychoanalytic Inquiry, 4: 367-399.

14. Dixon N: Preconscious Processing . Chichester: Wiley; 1981.

15. Holmes J: Attachment, Intimacy, Autonomy: Clinical Implications of Attachment Theory. New York: Jason Aronson.

 


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Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM

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Burying Freud

[ Burying Freud Homepage | Freud's Seduction Theory Homepage ]

EDITORIAL REVIEW

THE ASSAULT ON FREUD

Jeremy Holmes
Department of Psychiatry, North Devon District Hospital, Barnstaple,
Devon, UK, EX 31 4 JB.

Throughout its hundred-year history psychoanalysis has aroused violent passions. Calls to 'bury Freud' [1] continue unabated. The lines of these attacks have changed little since Eysenck`s ill-tempered bromide, now itself shown to be thoroughly flawed as a study [2]. Psychoanalysis is claimed to be unscientific -- either in a Popperian sense irrefutable [3], ineffective, or beneficial only via its placebo quality [4]. The psychoanalytic movement is likened to a cult, with its dogmata and high priests [5]. Freud himself is debunked, and claimed to be a cheat, a liar, an adulterer and an irascible paranoid sexist [6]. He is, in the 'seduction hypothesis', held responsible both for the misery of thousands of wrongly accused parents via the False Memory Syndrome [1], and, by his subsequent renunciation of the hypothesis, for the traumata of even greater numbers of children who actually were abused [7]. 

If this were merely an academic debate, Freud-bating might be seen as no more than a literary pastime, fostered by the publishing industry and academe, but of little practical significance in the world of psychotherapy. But as the market encroaches more and more on health-care such virulent attacks begin to take on a more definite and sinister shape. Health planners are in search of quick fixes -- briefer and cheaper alternatives to the costly treatments of the past. The psychotherapeutic equivalent of keyhole surgery is Cognitive Behaviour Therapy (CBT) which is set fair to become the dominant paradigm, at least within public-sector psychotherapy. In an age of pluralism, psychoanalysis is seen as merely one of 'the psychotherapies', and, according to some [8], an inessential one at that. Within the National Health Service, CBT is probably the most widely practiced variety of formal psychotherapy, especially among psychologists.

Should we welcome these developments., or will psychoanalysis, like hysteria, 'outlive its obituarists'? Mark Twain-like, are reports of its demise greatly exaggerated? It must first be acknowledged that the critique of psychoanalysis is not without foundation. Although there is fairly convincing evidence that psychoanalytic psychotherapy can be effective (see Barber & Ellman below), much work remains to be done, both at the level of outcome research and in probing the mode of action of psychoanalysis [9]. Psychoanalysis has been at times sequestered from the mainstream of academic debate, and has failed to take account of the findings of cognitive science, child development and even brain biochemistry in its world-view. As a movement it has been hierarchical, undemocratic and intolerant of dissent. No doubt Freud, and the other analytic pioneers were fraily human, not immaculate Gods.

But behind the attack on psychoanalysis lie a number of uncomfortable questions about the newer therapies, and a rediscovery of psychoanalytic concepts in a new guise. Long-term follow-up studies suggest that the initial enthusiasm for brief therapies such as CBT needs to be tempered. There is evidence that the relapse rate following brief therapy is disturbingly high -- five years post-treatment, as few as 20% of depressed patients remain relapse-free [10]. Co-morbid personality disorders dramatically worsens the prognosis of Axis 1 disorders. Some theoreticians such as Teesdale [11] have begun to question whether the supposed 'active principle' of CBT (questioning negative assumptions, finding alternatives to dichotomous thinking, challenging rules etc) is really what leads to change. Teesdale argues that the key ingredient is CBT`s capacity to help the patient to find new meanings and contexts for problematic feelings, and thus 'disidentify' himself from his symptoms -- which seems to bring us back to the psychoanalytic notion of insight. CBT practitioners [12] addressing the problems of personality disorder advocate much longer treatments than is traditional, and emphasise the importance of the therapist-patient relationship, including an understanding of transference and countertransference, as a determinant of outcome. 

Meanwhile contemporary psychoanalysis has moved a long way from classical metapsychology [9]. The unconscious is no longer seen primarily as a repository of infantile sexuality locked away by repression, only to be lifted by the arcane rituals of dream-interpretation. The Sandler`s [13] notion of the 'present unconscious' suggests that the main focus of psychoanalytic psychotherapy is on the thoughts, phantasies, and actions evoked in the patient by the therapeutic situation itself, and only secondarily on possible connections between these and the 'past unconscious'. This 'present unconscious' is clearly akin to CBT`s notion of 'automatic thoughts'. Unconsciousness is no longer seen as all-or-none, but as a gradation from vague awareness to full affective mastery (see Shapiro`s article below), and as a phenomenon is scientifically justified by the notion of unconscious perception [14]. Splitting and projection have taken over from repression as central mechanisms of defense: the aims of therapy are to reduce splitting and to lead to a more coherent and integrated sense of self -- highly relevant to the patients with borderline personality disorder who prove to be so problematic within psychiatric settings. Infantile sexuality is recast in terms of attachment theory in which adult personality is shaped by early attachment experience based around parental attunement, intrusiveness or neglect [15]. The oedipal situation, Freud's 'kernel of the neuroses', is today seen more as a metaphor than a description of real childhood events. The capacity to tolerate difference and separation, to use words and to reflect on oneself, all components of psychological health and thus aims for psychoanalytic psychotherapy, are seen in terms of the pain and gain of the 'depressive position' in which parental intercourse and ambivalence are accepted.

 The assault on Freud should not blind us to the immense contribution, both theoretical and practical, that psychoanalysis can make to psychotherapy. Psychotherapy needs psychoanalysis for three main reasons. First because psychoanalysis is in essence a science of relationships, and understanding relationships is close to the heart of psychotherapy, especially the balance between intimacy and boundaries that the psychoanalytic model has studied so intensively. Second, because psychoanalysis has emphasised so strongly the importance of early childhood temperament and handling as determinants of adult personality, a perspective that finally is beginning to be accepted in the wider world of psychiatry. Third, because psychoanalysis provides a guide to the inner world, offering a language for feelings that enables dumb suffering to be spoken, mental pain to be expressed.  

According to Whitehead a science which fails to forget its founders is doomed. Although psychoanalysis continues to pay due respect to its founder, Freud's presence often appears to loom larger in the eyes of its critics than its adherents. As psychoanalysis looks to the future, fruitful avenues of cross-fertilisation are opening up, among others with CBT and attachment-based therapies such as Interpersonal Therapy. If therapists can grasp these opportunities, and not be deflected by transient fashion or economic imperative, hybrid vigour will set psychotherapy in good shape for the 21st Century.

Jeremy Holmes

References

1. Tallis R: Burying Freud Lancet 1996, 347: 669-671.

2. McNeilly C, & Howard K: The effects of psychotherapy; a reevaluation based on dosage Psychotherapy Research 1991,1: 74-78.

3. Medawar P: Victims of psychiatry New York Review of Books 1975, Jan 23: 17-25.

4. Grunbaum, A: The Foundations of Psychoanalysis: A Philosophical Critique. Berkely: University of California Press; 1984.

5. Gellner E: The Psychoanalytic Movement. London: Paladin; 1985.

6. Webster R: Why Freud Was Wrong: Sin Science and Psychoanalysis. London: Harper Collins; 1995.

7. Masson J: The Assault on Truth: Freud`s Suppression of the Seduction Theory. London: Penguin; 1985.

8. Andrews G: The essential psychotherapies British Journal of Psychiatry 1993, 162: 447-451.

9. Bateman A, Holmes J: Introduction to Psychoanalysis: Contemporary Theory and Practice. London: Routledge; 1995.

10. Roth A, Fonagy P: Research on the Efficacy and Effectiveness of the Psychotherapies. London: Department of Health; 1996.

11. Teesdale J: The relationship between cognition and emotion: the mind-in-place in mood disorders. In D Clark & C. Fairburn (eds) Cognitive Behaviour Therapy: Science and Practice. Oxford; OUP; 1996.

12. Linehan M: Cognitive behaviour Therapy of Borderline Personality Disorder. New York: Guilford; 1993.

13. Sandler J, Sandler A-M: The past unconscious, the present unconscious and the interpretation of the transference Psychoanalytic Inquiry, 4: 367-399.

14. Dixon N: Preconscious Processing . Chichester: Wiley; 1981.

15. Holmes J: Attachment, Intimacy, Autonomy: Clinical Implications of Attachment Theory. New York: Jason Aronson.

 


human-nature.com
Ian Pitchford and Robert M. Young - Last updated: 28 May, 2005 02:29 PM

US -
 Search:
Keywords:  

Amazon.com logo

UK -
 Search:
Keywords:  

Amazon.co.uk logo

 | Human Nature | The Human Nature Daily Review | Psychiatry Research Online |